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Abstract: PO1305

Assessing Fluid Status of Peritoneal Dialysis Patients with Assistance of Lung Ultrasound (Fluid-PLUS)

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Ajuria, Michael, Stanford University School of Medicine, Stanford, California, United States
  • Hussein, Wael F., Satellite Healthcare, San Jose, California, United States
  • Abra, Graham E., Satellite Healthcare, San Jose, California, United States
  • Glinskii, Vladimir, Stanford University School of Medicine, Stanford, California, United States
  • Schiller, Brigitte, Satellite Healthcare, San Jose, California, United States
Background

Fluid overload (FO) is common in patients on dialysis, and is associated with increased cardiovascular morbidity and mortality. Clinical examination is limited in detecting FO. Lung ultrasound (US) is a portable and relatively inexpensive objective measure of FO. In this study, we aimed to evaluate the potential utility of lung US for evaluation of FO in patients on peritoneal dialysis (PD) in the ambulatory setting.

Methods

This is a cross-sectional, observational study at 4 home dialysis clinics in Northern California. Adult patients on PD attending routine outpatient visits were asked to participate. Patients on PD for less than 3 months or endorsing new or worsening shortness of breath were excluded. Participants underwent lung US examination. Based on the total number of B-lines, patients were classified as no US-fluid overload (< 16 lines), or US FO (>= 16 lines). Independently, nurses clinically evaluated patients’ fluid status and determined if a patient had clinical FO or no clinical FO.

Results

43 patients underwent full evaluation. Mean age was 55 +/- 15, 28% were female, 51% of patients had diabetes mellitus, and median PD vintage was 19 (IQR 10-37) months. Clinically, 13 (30%) of patients had FO. Lung US identified 15 patients (35%) as having FO.
Clinical and US findings were congruent in 35 (81%) patients, but discordant in 8 (19%) of patients. Of the 30 patients without clinical FO, 5 (17%) were identified with US FO. On the other hand, of the 13 patients with clinical FO, 3 (23%) had no US FO. – Figure (1). Agreement between clinical examination and lung US was moderate (kappa 0.58, 95% CI 0.32 to 0.84).

Conclusion

Lung US may identify a subset of patients with FO missed by clinical examination. Further studies are required to evaluate the impact of managing patients according to lung US findings on clinical outcomes.

Funding

  • Commercial Support